Yoga Training, Workshop & Retreat Intake Form

First & Last Name *
First & Last Name
Date of Birth *
Date of Birth
Address *
Phone Number (Home)
Phone Number (Home)
Phone Number (Cell)
Phone Number (Cell)
Emergency Contact Phone Number *
Emergency Contact Phone Number
Are you a yoga practitioner? *
Are you a yoga instructor? *
Are you a fitness instructor? *
If you are a yoga/fitness instructor, please provide the name and date of completion for any certifications that you have received for your training.
Waiver *
Yoga classes, workshops, retreats and trainings may include techniques, exercises and equipment (chairs, blocks, straps, weights, mats, eye bags and other tools) for developing strength, flexibility, endurance, relaxation, meditation and breath awareness. I acknowledge that there is some risk of personal injury from these activities. I agree to follow instructions carefully and take responsibility for my physical, emotional and spiritual well being. I, the undersigned, hereby release and forever discharge Julie Palmer, Yoga Teacher & Trainer, E-RYT 500, and her company Yoga for All, and organizers of events and owners of facilities where workshops, trainings and retreats are offered, from all actions, causes of action and exams of every kind or nature whatsoever, however caused. I also agree that my photo/video may be taken for memory, educational and promotional purposes.